Illuminated and vacuum assisted retractor

ABSTRACT

A retractor including: an extension member having distal and proximal ends; a retractor member connected to the distal end of the extension member, the retractor member having a retractor surface. In a first implementation, at least a portion of the retractor surface has a distal vacuum port for positively retaining the tissue upon application of a vacuum to the vacuum port. In an alternative implementation, the retractor has an illuminator for transmitting light into an interior of the body proximate to the tissue.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to retractors for retractingtissue, and more particularly, to an atrial retractor for use inretracting the heart wall during minimally invasive heart valve surgery.

2. Prior Art

Various types of surgical procedures are currently performed toinvestigate, diagnose, and treat diseases of the heart and the greatvessels of the thorax. Such procedures include repair and replacement ofmitral, aortic, and other heart valves, repair of atrial and ventricularseptal defects, pulmonary thrombectomy, treatment of aneurysms,electrophysiological mapping and ablation of the myocardium, and otherprocedures in which interventional devices are introduced into theinterior of the heart or a great vessel.

Many of these procedures require a gross thoracotomy, usually in theform of a median sternotomy, to gain access into the patient's thoracic.cavity. A saw or other cutting instrument is used to cut the stemumlongitudinally, allowing two opposing halves of the anterior or ventralportion of the rib cage to be spread apart. A large opening into thethoracic cavity is thus created, through which the surgical team maydirectly visualize and operate upon the heart and other thoraciccontents.

Surgical intervention within the heart generally requires isolation ofthe heart and coronary blood vessels from the remainder of the arterialsystem, and arrest of cardiac function. Usually, the heart is isolatedfrom the arterial system by introducing an external aortic cross clampthrough a sternotomy and applying it to the aorta between thebrachiocephalic artery and the coronary ostia. Cardioplegic fluid isthen injected into the coronary arteries, either directly into thecoronary ostia or through a puncture in the aortic root, so as to arrestcardiac function. In some cases, cardioplegic fluid is injected into thecoronary sinus for retrograde perfusion of the myocardium. The patientis placed on cardiopulmonary bypass to maintain peripheral circulationof oxygenated blood.

Of particular interest to the present invention are intracardiacprocedures for surgical treatment of heart valves, especially the mitraland aortic valves. Various surgical techniques may be used to repair adiseased or damaged valve, including annuloplasty (contracting the valveannulus), quadrangular resection (narrowing the valve leaflets),commissurotomy (cutting the valve commissures to separate the valveleaflets), shortening mitral or tricuspid valve chordae tendonae,reattachment of severed mitral or tricuspid valve chordae tendonae orpapillary muscle tissue, and decalcification of valve and annulustissue. Alternatively, the valve may be replaced, by excising the valveleaflets of the natural valve, and securing a replacement valve in thevalve position, usually by suturing the replacement valve to the naturalvalve annulus. Various types of replacement valves are in current use,including mechanical and biological prostheses, homografts, andallografts.

The mitral valve, located between the left atrium and left ventricle ofthe heart, is most easily reached through the wall of the left atrium,which normally resides on the posterior side of the heart, opposite theside of the heart that is exposed by a median stemotomy. Therefore, toaccess the mitral valve via a sternotomy, the heart is rotated to bringthe left atrium into an anterior position accessible through thestemotomy. An opening, or atriotomy, is then made in the right side ofthe left atrium, anterior to the right pulmonary veins. The atriotomy isretracted by means of sutures or retraction devices, exposing the mitralvalve directly posterior to the atriotomy. One of the aforementionedtechniques may then be used to repair or replace the valve.

An alternative technique for mitral valve access may be used when amedian sternotomy and/or rotational manipulation of the heart areundesirable. In this technique, a large incision is made in the rightlateral side of the chest, usually in the region of the fourthintercostal space. One or more ribs may be removed from the patient, andother ribs near the incision are retracted outward to create a largeopening into the thoracic cavity. The left atrium is then exposed on theposterior side of the heart, and an atriotomy is formed in the wall ofthe left atrium, through which the mitral valve may be accessed forrepair or replacement.

Using such open-chest techniques, the large opening provided by a mediansternotomy which enables the surgeon to see the mitral valve directlythrough the left atriotomy, and to position his or her hands within thethoracic cavity in close proximity to the exterior of the heart formanipulation of surgical instruments, removal of excised tissue, and/orintroduction of a replacement valve through the atriotomy for attachmentwithin the heart. However, these invasive, open-chest procedures producea high degree of trauma, a significant risk of complications, anextended hospital stay, and a painful recovery period for the patient.Moreover, while heart valve surgery produces beneficial results for manypatients, numerous others who might benefit from such surgery are unableor unwilling to undergo the trauma and risks of current techniques.

In response to the various problems associated with open-chestprocedures, new methods of performing closed-chest surgery on the heartusing minimally invasive thoracoscopic techniques have been recentlydeveloped. In these methods, the patient's heart is arrested byoccluding the patient's aorta between the coronary arteries and thebrachiocephalic artery with an expandable balloon on the distal end ofan endovascular catheter introduced via a femoral artery. Cardioplegicfluid is then delivered to the patient's myocardium through a lumen inthe same catheter or through a catheter positioned in the coronary sinusvia a peripheral vein. To repair or replace the mitral valve,minimally-invasive cutting and suturing instruments are then introducedthoracoscopically through a trocar sleeve in the right lateral portion fthe chest. A complete description of such methods is found in U.S. Pat.No. 5,571,215 to Sterman, et al., issued on Nov. 5, 1996, the contentsof which is incorporated herein by reference.

This new generation of thoracoscopic methods of performing heart valverepair has, of course, created many new challenges. One such challengeis that of retracting the left atrial wall to open the atriotomy so thatthe mitral valve can be exposed for the surgical procedure. The heartwall must be retracted anteriorly to suitably expose the mitral valveand provide access through the atriotomy for the cutting and suturinginstruments introduced through the right lateral portion of the chest.In addition, the instruments that retract the heart wall must beintroduced in a minimally-invasive manner through small percutaneousincisions or cannulae positioned in intercostal spaces in the patient'srib cage.

Introducing an instrument through an intercostal space in the anteriorside of the chest presents additional problems. One such problem is thatthe patient's rib cage is typically structured so that the ribs in theanterior portion of the chest are closer together than in the lateralportions of the chest. In addition, the tissue layer in the anteriorchest wall contains nerves that could be damaged by a large percutaneousincision. Therefore, a retraction device introduced from the anteriorside should be as small as possible, preferably on the order of 3-8 mm,to fit within the smaller anterior intercostal spaces and to avoidunnecessary trauma to the patient. Another problem is that the part ofthe retraction device that engages the heart wall must be wide enough toengage a sufficient portion of the heart wall to open the atriotomyenough to expose the mitral valve. It must also be long enough to extenda sufficient distance into the heart to extend beneath the interatrialseptum and prevent it from sagging or otherwise inhibiting access to themitral valve. Introducing an instrument that is large enough tosufficiently expose the mitral valve through the smaller intercostalspaces in the anterior portion of the chest is problematic.

U.S. Pat. No. 5,613,937 to. Garrison, et al., issued on Mar. 25, 1997,the contents of which are incorporated herein by reference, teaches suchan instrument. The retractor of U.S. Pat. No. 5,613,937 includes athreaded shaft and a retractor blade having a mating threaded portion.The retractor blade has a width and length sufficient to provide thenecessary retraction of the heart wall and has a thickness that allowsit to pass through a lateral thoracotomy. Therefore, the retractor bladeand threaded shaft are disassembled and the retractor blade ispositioned in the chest cavity. Once inside the chest cavity, the thinthreaded shaft is also passed through the intercostal space and is matedto the retractor blade. The retractor is then used to retract the leftatrial wall to open the atriotomy so that the mitral valve can beexposed for the surgical procedure. Generally, in these types ofretractors, surface texturing or raised projections are provided to keepthe heart wall from slipping off of the retractor blade. Since theretractors of the prior art use mechanical force applied to theretractor to hold the atrium open, it may cause the heart wall tocompress over time, which causes trauma and the need to adjust theretractor to compensate for the compression. Also due to the inherentforce needed to lift the heart wall, the chest wall (which supports theretractor) may be pulled down toward the heart instead of the heart wallbeing lifted. Furthermore, when such retractors are used to provideaccess to the mitral valve, illumination devices must also be used toilluminate the interior of the heart so that the surgeon can see thevalve and perform the necessary procedures. Typically, the illuminationdevice is an endoscope having a light fiber attached to a light sourceor a light source adapted to the surgeon's head, such as on his glassesor forehead. Therefore, illumination of the interior of the heartrequires additional instrumentation and because it is external to theheart interior, it often produces shadows and dark regions, which makeit difficult for the surgeon to visualize valves in the heart'sinterior.

SUMMARY OF THE INVENTION

Therefore it is an object of the present invention to provide aretractor that overcomes the disadvantages associated with retractors ofthe prior art.

Accordingly, a first implementation of a retractor is provided. Thefirst implementation retractor comprises: an extension member havingdistal and proximal ends; a retractor member connected to the distal endof the extension member, the retractor member having a retractorsurface, at least a portion of the retractor surface having a distalvacuum port for positively retaining tissue upon application of a vacuumto the vacuum port.

Preferably, the extension member is a tubular member having an internallumen extending from the proximal end to the distal end. The retractormember preferably has an internal conduit in fluid cooperation with boththe internal lumen and distal vacuum port, wherein vacuum applied to theproximal end of the extension member is applied to the distal vacuumport through the internal lumen and internal conduit. The retractorpreferably further comprising a handle disposed at the proximal end ofthe extension member, the handle having a proximal vacuum port in fluidcommunication with the proximal end of the internal lumen. Preferably,the distal end of the extension member has a male threaded portion andthe retractor member has a female threaded portion threadingly engagingthe male threaded portion of the extension member.

Preferably, the retractor member is a curved blade, the curved bladehaving a convex surface and a concave surface, wherein the distal vacuumport is at least partially formed in the convex surface. The convexsurface preferably further has at least one lip for preventing thetissue from slipping from the retractor surface.

The retractor preferably further comprises illumination means fortransmitting light into an interior of the body proximate to the tissue.Preferably, the illumination means comprises the retractor member havingat least a portion fabricated from a light transmitting material andlight guide means for directing the light to the light transmittingmaterial. The extension member is preferably a tubular member having aninternal lumen extending from the proximal end to the distal end,wherein a light fiber is disposed in the internal lumen for directingthe light to the light transmitting material. The retractor member ispreferably a curved blade, the curved blade having a convex surface anda concave surface, wherein the distal vacuum port is formed at leastpartially on the convex surface and the light transmitting material isat least partially formed in the concave surface.

Also provided is a second implementation retractor. The secondimplementation comprises: an extension member having a distal andproximal end; a retractor member connected to the distal end of theextension member, the retractor member having a retractor surface and isconfigured as a curved blade, the curved blade having a convex surfaceand a concave surface; and illumination means for transmitting lightinto an interior of the body proximate to tissue being retracted,wherein the illumination means transmits light from the concave surface.

Preferably, at least a portion of the retractor surface has a distalvacuum port for positively retaining the tissue upon application of avacuum to the vacuum port. The extension member is preferably a tubularmember having an internal lumen extending from the proximal end to thedistal end. Preferably, the retractor member has an internal conduit influid cooperation with both the internal lumen and distal vacuum port,wherein vacuum applied to the proximal end of the extension member isapplied to the distal vacuum port through the internal lumen andinternal conduit.

Preferably, the distal vacuum port is at least partially formed in theconvex surface. Preferably, the convex surface further has at least onelip for preventing the tissue from slipping from the retractor surface.Preferably, the distal end of the extension member has a male threadedportion and the retractor member has a female threaded portioncorresponding and threadingly engaging the male threaded portion of theextension member.

The illumination means preferably comprises the retractor member havingat least a portion fabricated from a light transmitting material andlight guide means for directing the light to the light transmittingmaterial. Preferably, the extension member is a tubular member having aninternal lumen extending from the proximal end to the distal end,wherein a light fiber is disposed in the internal lumen for directingthe light to the light transmitting material. The retractor preferablyfurther comprises a handle disposed at the proximal end of the extensionmember, the handle having a light guide connector in opticalcommunication with the light fiber in the internal lumen. Preferably,the retractor member is a curved blade, the curved blade having a convexsurface and a concave surface, wherein the distal vacuum port is formedat least partially on the convex surface and the light transmittingmaterial is at least partially formed in the concave surface.

Still provided is a first implementation of a method for retractingtissue for accessing a surgical site within a body of a patient, themethod comprising: engaging a surface of a retractor with the tissue tobe retracted; and providing a vacuum at the surface to positively holdthe tissue on the retractor surface. The method preferably furthercomprises directing light from the retractor to illuminate a body cavityproximate to the retractor.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects, and advantages of the apparatus andmethods of the present invention will become better understood withregard to the following description, appended claims, and accompanyingdrawings where:

FIG. 1 illustrates an isometric view of a preferred implementation of aretractor of the present invention.

FIG. 2 illustrates a partial isometric view of the retractor member andextension member of FIG. 1.

FIG. 3 illustrates a sectional view of the retractor member andextension member of FIG. 2 as taken along line 3-3 in FIG. 2, theretractor member being shown in cooperation with heart tissue and theextension member being shown disposed in an intercostal space betweenadjacent ribs.

FIG. 4 illustrates a partial sectional view of the handle and extensionmember of the retractor of FIG. 1 as taken along line 4-4 in FIG. 1.

FIG. 5 illustrates a sectional view of an alternative implementation ofthe retractor member and extension member of FIG. 2 as if it were takenalong line 3-3 in FIG. 2.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Although this invention is applicable to numerous and various types ofretractors for use with retraction of different tissue, it has beenfound particularly useful in the environment of an atrial retractor foruse in the retraction of the heart wall during minimally invasive heartvalve surgery. Therefore, without limiting the applicability of theinvention to an atrial retractor for use in the retraction of the heartwall during minimally invasive heart valve surgery, the invention willbe described in such enviromnent.

The invention provides methods and devices for performing surgicalinterventions within the heart or a great vessel such as the aorta,superior vena cava, inferior vena cava, pulmonary artery, pulmonaryvein, among other vessels. While the specific embodiments of theinvention described herein will refer to mitral valve repair andreplacement, it should be understood that the invention will be usefulin performing a great variety of surgical procedures, including repairand replacement of aortic, tricuspid, or pulmonary valves, repair ofatrial and ventricular septal defects, pulmonary thrombectomy, removalof atrial myxoma, patent foramen ovate closure, treatment of aneurysms,electrophysiological mapping and ablation of the myocardium, myocardialdrilling, annloplasty, artial fibulation, correction of congenitaldefects, and other procedures in which interventional devices areintroduced into the interior of the heart, coronary arteries, or greatvessels. Advantageously, the invention facilitates the performance ofsuch procedures through percutaneous penetrations within intercostalspaces of the rib cage, obviating the need for a median stemotomy orother form of gross thoracotomy.

The terms “percutaneous intercostal penetration” and “intercostalpenetration” as used herein refer to a penetration, in the form or asmall cut, incision, hole, cannula, trocar sleeve, or the like, throughthe chest wall between two adjacent ribs, wherein the patient's rib cageand sternum remain substantially intact, without cutting, removing, orsignificantly displacing the ribs or sternum. These terms are intendedto distinguish a gross thoracotomy such as a median sternotomy, whereinthe sternum and/or one or more ribs are cut or removed from the ribcage, or one or more ribs are retracted significantly, to create a largeopening into the thoracic cavity. A “percutaneous intercostalpenetration” may abut or overlap the adjacent ribs between which it isformed, but the maximum width of the penetration which is available forintroduction of instruments, prostheses and the like into the thoraciccavity will be the width of the intercostal space, bounded by twoadjacent ribs in their natural, substantially un-deflected positions. Itshould be understood that one or more ribs may be retracted or deflecteda small amount without departing from the scope of the invention;however, the invention specifically seeks to avoid the pain, trauma, andcomplications which result from the large deflection or cutting of theribs in conventional, open-chest techniques.

Referring now to FIG. 1, there is shown a preferred implementation of aretractor of the present invention, generally referred to by referencenumeral 100. In general, the retractor 100 includes an extension member102 having distal 104 and proximal 106 ends. A retractor member 108 isconnected to the distal end 104 of the extension member 102. Theretractor member 108 has a retractor surface 110 in contact with atissue to be retracted. At least a portion of the retractor surface 110has a distal vacuum port 112 for positively retaining the tissue uponapplication of a vacuum to the distal vacuum port 112.

Referring now also to FIGS. 2, 3, and 4 the preferred implementation ofthe retractor 100 will be described in more detail. Preferably, theextension member 102 is a tubular member having an internal lumen 114extending from the proximal end 106 to the distal end 104. Preferably,the extension member 102 is fabricated from surgical grade stainlesssteel. The distal end 104 of the extension member 102 has a means forcoupling and uncoupling it with the retractor member 108. Preferably,such means is provided by a male threaded portion 116 at the distal end104 of the extension member 102. In which case, the retractor member 108has a corresponding female threaded portion 118 threadingly engaging themale threaded portion 116 of the extension member 102. Those skilled inthe art will appreciate that other means for coupling and uncoupling theextension and retractor members 102, 108 are possible without departingfrom the scope or spirit of the prior art, such as a “bayonet” typemeans in which one or more projections (not shown) on the distal end 104of the extension member 102, engage a spiral slot (not shown) in theretractor member 108. The bayonet type means can also have a spring orother biasing means (not shown) for biasing the projections into alocked position in the slot. Other means include a “quick-connect” typeof coupling as is known in the art. Furthermore, it is preferred thatthe extension member 102 be used with many different size retractormembers for different surgical applications. Each of the different sizeretractor members 108 are interchangeably coupled and uncoupled from theextension member 102.

Preferably, a handle 120 is disposed at the proximal end 106 of theextension member 102. As well as providing a convenient place for asurgeon to grasp and manipulate the retractor 100, the handle 120 alsohas a proximal vacuum port 122 in fluid communication with the proximalend 106 of the internal lumen 114. The handle 120 has a main bore 124, adistal portion of which preferably has a counter bore 126 which is pressfit and/or adhered with an adhesive to the proximal end 106 of theextension member 102. Those skilled in the art will appreciate thatother means of fastening the handle to the extension member are possiblewithout departing from the scope or spirit of the present invention,such as a threaded connection similar to that described with regard tothe distal end 104 of the extension member 102. The proximal vacuum port122 is preferably a barbed fitting 122 as is known in the art. Thebarbed fitting is also preferably press fit and/or adhered with anadhesive into a side bore 128 which is in fluid communication with themain bore 124. The barbed fitting has an internal conduit 122 a and oneor more external barbs 130 over which flexible tubing is sealinglydisposed. The flexible tubing (not shown) is attached to a vacuum source(not shown) such as a vacuum pump (not shown) for generating a vacuum atthe proximal vacuum port 122. Other types of vacuum fittings are alsopossible, such as luer fittings known in the medical arts. Furthermore,a syringe (not shown) may be connected directly to the flexible tubingfor applying a vacuum at the proximal vacuum port 122.

The retractor member 108 preferably has an internal conduit 132 in fluidcooperation with both the internal lumen 114 of the extension member 102and the distal vacuum port 112. The internal conduit 132 preferablycomprises two segments, a first segment 132 a, which is a continuationof the female thread 118, and a second segment 132 b that connects thefirst segment 132 a to the distal vacuum port 112. The distal vacuumport 112 is preferably shaped to cover a major portion of the retractorsurface 110, such as a rectangle. Those skilled in the art willappreciate that other shapes or several shapes and ports are possiblewithout departing from the scope or spirit of the present invention.From the foregoing description, those skilled in the art will alsoappreciate that vacuum applied to the proximal end of the extensionmember is applied to the distal vacuum port 112 through the internallumen 114 and internal conduit 132. Where the handle 120 is provided,the vacuum applied at the proximal vacuum port 122 is applied to thedistal vacuum port 112 through the conduit 122 a, side bore 128, mainbore 124, internal lumen 114 and internal conduit 132. Those skilled inthe art will appreciate that the vacuum path to the distal vacuum port112 may vary from that described above with regard to the preferredimplementation of the retractor 100. For example, a vacuum port may beprovided directly on a surface of the retractor member 108 and aflexible tube connected thereto and to a vacuum source can be externalto the extension member 102. As discussed below, the retractor member108 is preferably fabricated from a transparent material, at least aportion of which is fabricated from a light transmitting material, tofacilitate illuminating an interior of the body proximate the retractormember 108. However, as shown in FIG. 5, the retractor 100 may beconfigured without such an illumination means, and as such, may befabricated from any appropriate medically approved material, such as athermoplastic, or stainless steel.

The retractor surface 110 of the retractor member 108 is configured toretract tissue, preferably, heart tissue. Preferably, the retractormember 108 is shaped as a curved rigid blade wherein the retractorsurface 110 is a convex surface 134 and the retractor member 108 furtherhas a concave surface 136. The distal vacuum port 112 is preferably atleast partially formed in the convex surface 134 corresponding to theretractor surface 110. The convex surface 134 further has at least onelip 138 for preventing the tissue from slipping from the retractorsurface 110. Although, suction generated at the distal vacuum port 112may act to positively retain the tissue on the retractor surface 110,the lip 138 provides additional retention of the tissue and may serve toretain the tissue while the retractor 100 is being positioned and beforethe vacuum is applied or fully established.

As discussed briefly above, the retractor 100 preferably furthercomprises illumination means for transmitting light into an interior ofthe body proximate to the tissue. The illumination means preferablycomprises the retractor member 108 having at least a portion fabricatedfrom a light transmitting material and light guide means for directingthe light to the light transmitting material. In the preferredimplementation of the retractor 100 discussed above where the extensionmember 102 is a tubular member having an internal lumen 114, a lightfiber 140 is disposed in the internal lumen 114 for directing the lightto the light transmitting material. Where suction is also provided atthe retractor surface 110, the vacuum is applied through an annularspace between the exterior surface of the light fiber 140 and aninterior surface of the internal lumen 114. Furthermore, the handle 120includes a light guide coupling 142 for coupling a light guide cable(not shown) from a light source (not shown) to the light fiber 140.Light guide couplings 142 for coupling light sources to internal lightfibers 142 or optics are well known in the medical arts, particularly inthe endoscope arts.

Preferably, the retractor member 108 is fabricated from a transparentmaterial and has a light pipe 144 molded therein. The light pipe 144 isfabricated from a light transmitting material, such as polycarbonate.The light fiber 140 directs light onto a surface of the light pipe 144,which directs the light as desired. Where, the retractor member 108 is acurved blade as discussed above, having a convex surface 134 and aconcave surface 136, the light transmitting material, e.g., the lightpipe 144, is at least partially formed in the concave surface 136 todirect the light from the concave surface 136. Preferably, small lenses145, such as Microlens® manufactured by Lumitex Inc., are molded intothe concave surface 136 in the vicinity of the light pipe 144 to directthe light A from the concave surface 136 at a predetermined angle a withrespect to the concave surface 136. In this way, light is diffuselydelivered into an operative area through the retractor member 108. Thepredetermined angle α can be chosen depending on the application for theretractor 100. When used in mitral valve repair or replacement, thepreferred angle α is approximately 30 degrees. When using the smalllenses 145 molded in the concave surface 136, it is preferred that anadditional layer 146 is disposed on the concave surface 136. Theadditional layer 146 can be molded onto the retractor member 108 as asecondary operation to the fabrication of the retractor member 108.However, it is preferred that the additional layer be a thin transparentadhesive label that is adhered to the concave surface 136.

In addition to performing mitral valve repair and replacement, thetechniques of the invention also facilitate surgical intervention intoother regions of the heart and great vessels and may also be used inother vessels and organs in general. The devices and methods describedabove may be used to form an opening directly into the left ventricle,right atrium, or right ventricle, or into a great vessel such as theaorta, superior vena cava, inferior vena cava, pulmonary artery, orpulmonary vein, for surgical intervention in such cavities. For example,a penetration may be made in the wall of the aorta, and the aortic valvemay be repaired or replaced with prosthesis, using techniques anddevices like those described above for mitral valve replacement.Moreover, the devices and methods of the invention also facilitateintercardiac procedures such as repair of atrial or ventricular septaldefects, electrophysiological mapping and ablation of the myocardium,myocardial drilling, and other procedures. Furthermore, devices may beintroduced through an opening into the heart or great vessel andadvanced therefrom into vessels such as the coronary arteries to performprocedures such as angioplasty, atherectomy, coronary artery bypassgrafting, or treatment of aneurysms. The retractor 100 is preferablyused in combination with a thoracotomy or stemotomy retractor or used asa stand-alone retractor system that uses the patient's chest wall as itsopposing force. Preferably, the retractor 100 is fastened to thethoracotomy or stemotomy retractor by using a ball socket clamp as isknown in the art. The ball socket clamp preferably grasps the retractor100 by the extension member 102.

EXAMPLE

An example procedure using the preferred implementation retractor 100 ofthe present invention for minimally invasive mitral valve surgery willnow be described with reference to FIGS. 3 and 4. The extension member102 with light fiber 140 is inserted first using a stab incision throughan intercostals space 148 on the patients chest between adjacent ribs150, 152. The retractor member 108 is then inserted into the operativespace through a lateral thoracotomy and is threaded onto the distal end104 of the extension member 102. Once the extension member 102 isattached to the retractor member 108, a light source (not shown) andvacuum line (not shown) are attached to the light guide coupling 142 andproximal vacuum port 122, respectively. The connection of the lightfiber to the retractor member 108 is inherently made when the extensionmember 102 is connected to the retractor member 108. The retractormember 108 is then positioned in the right atrium of the heart 154through an atriotomy 156. Once the retractor 100 is in place, thesuction is turned on to hold the position of the retractor member 108relative to the heart 154. The extension member 102 is then attached toa thoracotomy retractor (not shown) or can be used on its own by usingthe patients chest for the opposing force once the atrium wall islifted. The latter would be done by using a clamp around the extensionmember 102 or an assisting device such as an “Atrial Assistant”manufactured by Heartport Inc. Once the retractor 100 is anchored, thelight source (not shown) is turned on to illuminate the interior 158 ofthe heart 154 including the atrium and the mitral valves. The physicianthen repairs of replaces the atrium and/or mitral valves as discussedabove and as is known in the art.

While there has been shown and described what is considered to bepreferred embodiments of the invention, it will, of course, beunderstood that various modifications and changes in form or detailcould readily be made without departing from the spirit of theinvention. It is therefore intended that the invention be not limited tothe exact forms described and illustrated, but should be constructed tocover all modifications that may fall within the scope of the appendedclaims.

1-23. (canceled)
 24. A retractor comprising: an extension member havingdistal and proximal ends; a retractor member connected to the distal endof the extension member, the retractor member having an upper and lowerretractor surface; and a distal vacuum port formed into at least aportion of the upper retractor surface for positively retaining tissueto be retracted upon application of a vacuum to the distal vacuum port.25. The retractor of claim 24, wherein the extension member is a tubularmember having an internal lumen extending from the proximal end to thedistal end.
 26. The retractor of claim 25, wherein the retractor memberhas an internal conduit in fluid cooperation with both the internallumen and distal vacuum port, wherein vacuum applied to the proximal endof the extension member is applied to the distal vacuum port through theinternal lumen and internal conduit.
 27. The retractor of claim 26,further comprising a handle disposed at the proximal end of theextension member, the handle having a proximal vacuum port in fluidcommunication with the proximal end of the internal lumen.
 28. Theretractor of claim 24, wherein the retractor member is a curved bladehaving a convex surface and a concave surface, wherein the distal vacuumport is at least partially formed in the convex surface.
 29. Theretractor of claim 25, wherein the distal end of the extension memberhas a male threaded portion and the retractor member has a femalethreaded portion threadingly engaging the male threaded portion of theextension member.
 30. The retractor of claim 24, further comprisingillumination means for transmitting light into an interior of a bodycavity proximate to the tissue.
 31. The retractor of claim 30, whereinthe illumination means comprises the retractor member having at least aportion fabricated from a light transmitting material and light guidemeans for directing light to the light transmitting material.
 32. Theretractor of claim 31, wherein the extension member is a tubular memberhaving an internal lumen extending from the proximal end to the distalend, wherein a light fiber is disposed in the internal lumen fordirecting the light to the light transmitting material.
 33. Theretractor of claim 32, further comprising a light pipe molded at leastpartially into the concave surface of the retractor member for directingthe light received from the light guide means to the interior of thebody cavity.
 34. The retractor of claim 33, wherein the light pipefurther comprises lenses molded into the concave surface for directingthe light at an angle relative to the concave surface.
 35. The retractorof claim 34, wherein the angle of the lenses varies according to asurgical procedure performed with the retractor.
 36. The retractor ofclaim 31, wherein the retractor member is comprised of transparentmaterials at least a portion of which is the light transmittingmaterial.
 37. The retractor of claim 32, wherein the retractor member isa curved blade, the curved blade having a convex surface and a concavesurface, wherein the distal vacuum port is formed at least partially onthe convex surface and the light transmitting material is at leastpartially formed in the concave surface.
 38. The retractor of claim 24,further comprising a flexible tube connected to the retractor member andto an external vacuum source to provide the vacuum to the distal vacuumport.
 39. A retractor comprising: an extension member having a distalend and a proximal end; a retractor member connected to the distal endof the extension member and having a retractor surface configured as acurved blade, the curved blade having an upper convex surface and alower concave surface; and illumination means for transmitting lightinto an interior of a body cavity proximate to tissue being retracted,wherein the illumination means transmits light from the lower concavesurface.
 40. The retractor of claim 39, wherein at least a portion ofthe retractor surface has a distal vacuum port for positively retainingthe tissue upon application of a vacuum to the vacuum port.
 41. Theretractor of claim 40, wherein the extension member is a tubular memberhaving an internal lumen extending from the proximal end to the distalend.
 42. The retractor of claim 41, wherein the retractor member has aninternal conduit in fluid cooperation with both the internal lumen andthe distal vacuum port, wherein vacuum applied to the proximal end ofthe extension member is applied to the distal vacuum port through theinternal lumen and internal conduit.
 43. The retractor of claim 40,wherein the distal vacuum port is at least partially formed in theconvex surface.
 44. The retractor of claim 39, wherein the distal end ofthe extension member has a male threaded portion and the retractormember has a female threaded portion corresponding and threadinglyengaging the male threaded portion of the extension member.
 45. Theretractor of claim 39, wherein the illumination means comprises theretractor member having at least a portion fabricated from a lighttransmitting material and light guide means for directing the light tothe light transmitting material.
 46. The retractor of claim 45, whereinthe extension member is a tubular member having an internal lumenextending from the proximal end to the distal end, wherein a light fiberis disposed in the internal lumen for directing the light to the lighttransmitting material.
 47. The retractor of claim 46 further comprisinga handle disposed at the proximal end of the extension member, thehandle having a light guide connector in optical communication with thelight fiber in the internal lumen.
 48. A method for retracting tissuefor accessing a surgical site within a body of a patient, the methodcomprising: engaging an upper surface of a retractor with tissue to beretracted; retaining the tissue on the upper surface of the retractor;and providing a vacuum at the upper surface to positively hold thetissue on the retractor surface.
 49. The method of claim 48, furthercomprising directing light from a lower surface of the retractor toilluminate a body cavity proximate to the retractor.